Lifesaving skills
Use these lifesaving skills as a part of initial assessment. If you only use these skills without assessing all of the person's potential life threats, you may save them from one emergency only to lose them to another. These skills are focused on helping a person to breathe. A person can die within 4 minutes if they do not breathe. Head tilt- chin lift The airway starts at the nose and mouth and ends deep in the chest where oxygen is exchanged for carbon dioxide. In an unresponsive person, the most common obstructions are the back of the tongue and the epiglottis. By gently tilting their head back, and pulling their jaw forward-- the head tilt- chin lift maneuver-- most airways can be opened. When you have completed your assessment, roll the person into recovery position. An unresponsive person will not remain with head tilted and chin lifted unless held constantly, and it does not safeguard against risks due to fluids. Jaw thrust If a spine injury is suspected, use the jaw thrust maneuver, a maneuver that does not endanger the spinal cord, to open the airway. Place your fingers behind the victims jaw bones, on both sides, just below the ear. Then push forward so the jaw juts out away from the face. Back blows and abdominal thrusts In a conscious person, food is the most common airway obstruction. Ask "are you choking?" If the person can speak or cough, encourage them to cough, watch and wait. If the person goes silent or starts to wheeze, quickly do this: *Give back blows: **Stand to the side and slightly behind the person. **Support their chest with one hand and help them lean far forward. This helps the obstruction to come out of the mouth instead of being gasped back into their airway. **Give up to five back blows between their shoulder blades with the heel of your other hand. **Check to see if each back blow has removed the obstruction. This will be indicated by breathing or coughing. The aim is to relieve the obstruction with any blow, not to give all five. *If the person is choking after the back blows, give abdominal thrusts: **Stand behind the person and wrap your arms around their waist. **Help the person to lean far forward. **Make a fist with one hand. Press your fist into their abdomen, thumb side of fist in, above their navel and below their ribs. **Cup your fist with your second hand. Pull in and up with a sudden strong upward jerk. *If the object is not expelled, you may alternate five back blows with five abdominal thrusts until it works. This forces the air from the person's lungs and should free their throat. If the person becomes unresponsive before their airway is clear, *Lower the person gently to the ground. *Open their mouth with a gloved hand and look in to see if there is an object you can observe and remove. *Quickly follow the directions below. If the person is a lot bigger than you or is already unresponsive, quickly follow the directions in the next section. Abdominal thrusts on the ground *Lay the person on their back. *Tilt their head to one side. *Sit over them. Put the heel of one hand on their belly between their navel and ribs. Put your other hand on top of the bottom hand. **For fat persons, pregnant women, persons in wheelchairs, or small children, place hands in the center of their chest (on their breastbone or sternum), not the belly. *Make a quick, strong upward push. *If the object is not expelled, repeat several times. *If the person still cannot breathe, try rescue breathing (see below). If the person starts breathing again but remains unresponsive, keep their airway open by rolling them into recovery position. Wait with them for advanced care. Constantly monitor their breathing, by frequent quick Initial assessments. NOTE: The AHA no longer recommends this practice, and is typically no longer the standard of care. If a choking subject becomes unresponsive, begin CPR. Rescue breathing Common causes for breathing to stop are: *something stuck in the throat *the tongue or thick mucus blocking the throat of an unconscious person *drowning, choking on smoke, or poisoning *a drug overdose *a strong blow to the head or chest *a heart attack Do all of the following as quickly as you can: Step 1: Quickly use your gloved finger to remove anything stuck in their mouth or throat. Pull their tongue forward. If there is mucous or vomit in their throat, turn their head to the side and quickly try to sweep it out. Step 2: Quickly but gently lay the person face up. Do the head tilt- chin lift (Gently tilt their head back, and pull their jaw forward). Step 3: Pinch their nostrils closed, open their mouth wide, seal your mouth over their mouth (protect yourself with a barrier such as a rescue mask or plastic bag with a small hole over the mouth), and attempt to blow air into their lungs so that their chest rises. *If your air won't go in, reposition their head and try again. You can also try the abdominal thrusts on the ground, described above. *If your air does go in, pause to let the air come back out and blow again. Repeat about once every 5 seconds. **With babies and small children, cover the nose and mouth with your mouth (and a BSI barrier) and breathe very gently about once every 3 seconds. Continue rescue breathing until the person can breathe without help, until advanced care arrives, or until there is no doubt the person is dead. Sometimes you must keep trying for an hour or more. You may pause every 2 minutes to check for a heart beat. A beating heart will be indicated by breathing, coughing, movement, and/or a pulse. To check for a pulse, place two or three of your fingers over the person's carotid artery, in the valley between the windpipe and the large neck muscle, with your top finger resting against the angle of the jaw. Make a note about whether their heart is beating and continue rescue breathing. If the person starts breathing again but remains unresponsive, keep their airway open by rolling them into recovery position. Wait with them for advanced care. Constantly monitor their breathing, by frequent quick Initial assessments. Recovery position The recovery position helps to protect the airway of an unresponsive person, so that the person can breathe. When an unresponsive person is lying face upwards, there are two main risks factors which can lead to suffocation: *The back of the tongue or can obstruct their airway. *Fluids (blood or vomit) can collect in the back of the throat, causing them to drown. These are common causes of death when someone passes out drunk or is otherwise poisoned. If the person is placed in the recovery position, the action of gravity will both keep the tongue from obstructing the airway and also allow any fluids to drain. Also the chest is raised above the ground, which also helps to make breathing easier. The following steps describe how to put someone in the recovery position. Note that even if the exact steps are not remembered, it is still generally much better to turn an unconscious person onto their side than to leave them on their back. * Put yourself in a position where you can pull the person toward you. Your own body can serve as a brake if the person's weight is more than you can control as you turn them. * Place their arm closest to you with right angles at both the shoulder and the elbow, in a "hand up" position. (Depending on the person, the back of the hand may touch the ground or it may not. If not, do not force it down.) * Raise the knee of the far leg. The foot of the far leg should end up flat on the ground, approximately next to the knee of the near leg. * Bring the hand of the far arm against the person's near cheek (palm outwards) and support it with your hand. * Turn the person onto the side by gently pulling the raised knee / thigh of the far leg, while continuing to hold the person's hand against their cheek with your other hand, thereby supporting the head. (Pulling the leg gives a lot of mechanical advantage, so with most patients you should not need to use a lot of force.) * When you have the person on their side, tilt the head back to ensure an open airway. Adjust the hand under the cheek, if necessary, to keep the head tilted. Check the person's breathing. * For maximum stability, position the upper leg so that there are right angle bends at both the hip and the knee. Breathing should be monitored closely. In the event that breathing stops, the head position should be checked and the airway cleared. If this does not immediately restart breathing, then rescue breaths should be started immediately. If the person has to be kept in the recovery position for more than 30 min turn them to the opposite side to relieve the pressure on the lower arm. Precautions * Do not put an alert person who has fallen on his back into recovery position if he or she is not choking. This does no good and might worsen possible injuries to the spine. * If there is conflict between keeping the integrity of the spine and putting an unresponsive patient in recovery position, the recovery position has priority. Better to have a living patient with a damaged spine than a dead one with an intact spine. * A person with a chest injury should be turned onto the injured side. This is to ensure that any blood within the chest cavity is more likely to affect only one lung rather than both of them, and if one lung is injured then the good lung is positioned off the ground making it easier to breathe. * Pregnant women: always put an unconscious pregnant woman in recovery position on her left side. This prevents compression of the Inferior vena cava by the uterus, which could be fatal for both the mother and the child. * It is possible to compress bleeding injuries by putting the patient in recovery position on the bleeding side. A bleeding pregnant woman must be put on her left side no matter what. * Before turning a person, ensure that the ground beside them is free from objects which can cause injury. Also, remove hard or bulky objects from pockets on the near side. Notes This material is intended as a training supplement. Reading this material is no substitute for first aid / medical training with a qualified trainer. We encourage you to pursue ongoing education, reviewing and upgrading your skills-- for the safety of both yourself and anyone you treat. Category:Protocol